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Review
. 2025 Jul 14;17(8):848-858.
doi: 10.1136/jnis-2024-022144.

Neuroanatomy of the vertebrobasilar perforators: implications for aneurysm treatment

Eytan Raz  1 , Maksim Shapiro  2 , Erez Nossek  2 , Daniel H Sahlein  3 , Matthew B Potts  4 , Vera Sharashidze  2 , Charlotte Chung  2 , Caleb Rutledge  2 , Ayaz Mahmood Khawaja  5 , Howard A Riina  2 , Reade Andrew De Leacy  6 , Svetlana Kvint  2 , Peter Kim Nelson  2
Affiliations
Review

Neuroanatomy of the vertebrobasilar perforators: implications for aneurysm treatment

Eytan Raz et al. J Neurointerv Surg. .

Abstract

The anatomy of vertebrobasilar perforators has been widely studied in human cadavers, with most reports found in the neurosurgical literature. These arterial perforators are extremely hard to visualize consistently with traditional two-dimensional digital subtraction angiography, but are reliably visible with cross sectional cone beam CT techniques. A clear understanding of this specific neurovascular anatomy and pathology is essential for informed treatment decisions. This review analyzes the anatomy of vertebrobasilar perforators with a focus on practical implications for aneurysm treatment, particularly flow diversion.

Keywords: Aneurysm; Artery; Brain; Device; Flow Diverter.

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Conflict of interest statement

Competing interests: ER: Consultant for Balt, Cerenovus, Imperative Care, Medtronic, Microvention, Phenox, Qapel, Scientia, Vasorum. Site PI for PROST, Inspire, NECC. Off label use of Pipeline Embolization Device. RDL: Consultant for Imperative Care, Stryker Neurovascular; Scientific Advisory Board Cerenovus. Equity: Synchron, Endostream, Borvo Medical, Von Medical, Vastrax, Precision Health Care. Research Support: Siemens Healthineers, SNIS Foundation, Kaneka Medical.

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